Objective To investigate diagnostic efficacy of transvaginal three-dimensional hysterosalpingo-contrast sonography(3D-Hy Co Sy) in assessing tubal patency with chromolaporoscopy. Methods A total of 157 infertile women...Objective To investigate diagnostic efficacy of transvaginal three-dimensional hysterosalpingo-contrast sonography(3D-Hy Co Sy) in assessing tubal patency with chromolaporoscopy. Methods A total of 157 infertile women underwent 3D-Hy Co Sy to evaluate tubal patency. Among these patients, 39 patients were also examined by chromolaporoscopy. The concordance of the two clinical assessment methods was analyzed by the Kappa coefficient test. Results Among the 306 oviducts examined by 3D-Hy Co Sy, 99(32.4%) were patent, 126(41.2%) partially obstructed, and 81(26.5%) completely obstructed. Diagnostic results with 3D-Hy Co Sy were not statistically different from those obtained in the 39 women(78 oviducts) who also underwent chromolaporoscopy, and the two methods showed a high concordance(κ=0.747, P=0.000). The 3D-Hy Co Sy procedure had a sensitivity of 84.8%(28/33), a specificity of 96.2%(25/26), and positive and negative predictive values of 93.3%(28/30) and 86.2%(25/29) respectively. Conclusion Transvaginal 3D-Hy Co Sy can accurately reveal the spatial path and morphology of the oviduct and is a safe and effective method to evaluate tubal patency.展开更多
AIM To evaluate the diagnostic value of different sonographic methods in hemorrhoids.METHODSForty-two healthy volunteers and sixty-two patients with gradesⅠ-Ⅳhemorrhoids received two different sonographic examinatio...AIM To evaluate the diagnostic value of different sonographic methods in hemorrhoids.METHODSForty-two healthy volunteers and sixty-two patients with gradesⅠ-Ⅳhemorrhoids received two different sonographic examinations from January 2013 to January2016 at the First and Second Hospitals of Xinjiang Medical University in a prospective way.We analyzed the ultrasonographic findings of these participants and evaluated the outcomes.Resected gradesⅢandⅣhemorrhoid tissues were pathologically examined.The concordance of ultrasonographic results with pathologyresults was assessed with the Cohen’s kappa coefficient.RESULTS All healthy volunteers and all patients had no particular complications related to sonography.There were no statistically significant differences between the participants regarding age(P=0.5919),gender(P=0.4183),and persistent symptoms(P>0.8692).All healthy control participants had nospecial findings.However,30 patients with hemorrhoids showed blood signals around the dentate line on ultrasonography.When gradesⅠandⅡhemorrhoids were analyzed,there were no significant differences between transrectal ultrasound(TRUS),transperianal ultrasound(TPUS),and transvaginal ultrasound(TVUS)(P>0.05).GradesⅢandⅣhemorrhoids revealed blood flow with different directions which could be observed as a"mosaic pattern".In patients with gradesⅢandⅣhemorrhoids,the number of patients with"mosaic pattern"as revealed by TRUS,TPUS and TVUS was 22,12,and 4,respectively.Patients with gradesⅢandⅣdisease presented with a pathologically abnormal cushion which usually appeared as a"mosaic pattern"in TPUS and an arteriovenous fistula in pathology.Subepithelial vessels of resected gradesⅢandⅣhemorrhoid tissues were manifested by obvious structural impairment and retrograde and ruptured changes of internal elastic lamina.Some parts of the Trietz’s muscle showed hypertrophy and distortion.Arteriovenous fistulas and venous dilatation were obvious in the anal cushion of hemorhoidal tissues.After pathological results with arteriovenous fistulas were taken as the standard reference,we evaluated the compatibility between the two methods according to the Cohen’s kappa coefficiency calculation.The compatibility(Cohein kappa co-efficiency value)between"mosaic pattern"in the TPUS and arteriovenous fistula in pathology was very good(?=0.8939).When compared between different groups,TRUS presented the advantage that the mosaic pattern could be confirmed in more patients,especially for group A.There was a statistical difference when comparing group A with group B or C(P<0.05 for both).There were obvious statistical differences between group A and group B with regard to the vessel diameter and blood flow velocity measured by TRUS(P<0.05).CONCLUSION Patients with gradesⅢandⅣhemorrhoids present with a pathologically abnormal cushion which usually appears as a"mosaic pattern"in sonography,which is in accord with an arteriovenous fistula in pathology.There are clearly different hemorrhoid structures shown by sonography."Mosaic pattern"may be a parameter for surgical indication of gradesⅢandⅣhemorrhoids.展开更多
BACKGROUND： A preoperative diagnosis of primary hepatic lymphoma（PHL） can have profound therapeutic and prognostic implications. Because of the rarity of PHL, however, there are few reports on diagnostic imaging. W...BACKGROUND： A preoperative diagnosis of primary hepatic lymphoma（PHL） can have profound therapeutic and prognostic implications. Because of the rarity of PHL, however, there are few reports on diagnostic imaging. We reviewed the clinical and radiologic findings of 29 patients with PHL, the largest series to date, to evaluate the diagnostic features of this disease.METHODS： Clinical data and radiologic findings at presentation were retrospectively reviewed for 29 patients with pathologically confirmed PHL from January 2005 to June 2013. Imaging studies, including ultrasound（US）（n=29） and contrast-enhanced computed tomography（CECT）（n=24）, were performed within 2 weeks before biopsy or surgery.RESULTS： Among the 29 patients, 23（79%） were positive for hepatitis B virus（HBV） and 26（90%） had a significantly elevated level of serum lactate dehydrogenase（LDH）. There were two distinct types of PHL on imaging： diffuse（n=5） and nodular（n=24）. Homogeneous or heterogeneous hepatomegaly was the only sign for diffuse PHL on both US and CECT, without any definite hepatic mass. For the nodular type, 63%（15/24） of patients had solitary lesions and 38%（9/24） had multiple lesions. On US, seven patients displayed patchy distribution with an indistinct tumor margin and a rich color flow signal. CECT showed rim-like enhancement（n=3） and slightly homogeneous or heterogeneous enhancement（n=14） in the arterial phase and isoenhancement（n=5） and hypoenhancement（n=12） in the portal venous and late phases. Furthermore, in five patients, CT revealed that hepatic vessels passed through the lesions and were not displaced from the abnormal area or appreciably compressed.CONCLUSIONS： The infiltration type of PHL was associated with the histologic subtype. Considered together with HBV positivity and elevated LDH, homogeneous or heterogeneous hepatomegaly may indicate diffuse PHL, whereas patchy distribution with a rich color flow signal on US or normal vessels extending through the lesion on CECT may be the diagnostic indicators of nodular PHL.展开更多
BACKGROUND Neuropathy is a common complication of diabetes mellitus resulting from direct damage by hyperglycemia to the nerves and/or ischemia by microvascular injury to the endoneurial vessels which supply the nerve...BACKGROUND Neuropathy is a common complication of diabetes mellitus resulting from direct damage by hyperglycemia to the nerves and/or ischemia by microvascular injury to the endoneurial vessels which supply the nerves. Median nerve is one of the peripheral nerves commonly affected in diabetic neuropathy. The median nerve size has been studied in non-Nigerian diabetic populations. In attempt to contribute to existing literature, a study in a Nigerian population is needed.AIM To evaluate the cross-sectional area(CSA) of the median nerve using B-mode ultrasonography(USS) and the presence of peripheral neuropathy(PN) in a cohort of adult diabetic Nigerians.METHODS Demographic and anthropometric data of 85 adult diabetes mellitus(DM) and 85 age-and sex-matched apparently healthy control(HC) subjects were taken. A complete physical examination was performed on all study subjects to determine the presence of PN and modified Michigan Neuropathy Screening Instrument(MNSI) was used to grade its severity. Venous blood was taken from the study subjects for fasting lipid profile(FLP), fasting blood glucose(FBG) and glycated haemoglobin(HbA1 c) while their MN CSA was evaluated at a point 5 cm proximal to(5 cmCATL) and at the carpal tunnel(CATL) by high-resolution Bmode USS. Data was analysed using SPSS version 22.RESULTS The mean MN CSA was significantly thicker in DM subjects compared to the HC at 5 cmCATL(P < 0.01) and at the CATL(P < 0.01) on both sides. The presence of diabetic peripheral neuropathy(DPN) further increased the MN CSA at the CATL(P < 0.05) but not at 5 cmCATL(P > 0.05). However, the severity of DPN had no additional effect on MN CSA 5 cm proximal to and at the CATL. There was no significant association between MN CSA and duration of DM and glycemic control.CONCLUSION Thickening of the MN CSA at 5 cmCATL and CATL is seen in DM. Presence of DPN is associated with worse thickening of the MN CSA at the CATL but not at5 cmCATL. Severity of DPN, duration of DM, and glycemic control had no additional effect on the MN CSA.展开更多
Fetal malformations are very frequent in industrialized countries.Although advanced maternal age may affect pregnancy outcome adversely,80%-90%of fetal malformations occur in the absence of a specific risk factor for ...Fetal malformations are very frequent in industrialized countries.Although advanced maternal age may affect pregnancy outcome adversely,80%-90%of fetal malformations occur in the absence of a specific risk factor for parents.The only effective approach for prenatal screening is currently represented by an ultrasound scan.However,ultrasound methods present two important limitations:the substantial absence of quantitative parameters and the dependence on the sonographer experience.In recent years,together with the improvement in transducer technology,quantitative and objective sonographic markers highly predictive of fetal malformations have been developed.These markers can be detected at early gestation(11-14 wk)and generally are not pathological in themselves but have an increased incidence in abnormal fetuses.Thus,prenatal ultrasonography during the second trimester of gestation provides a"genetic sonogram",including,for instance,nuchal translucency,short humeral length,echogenic bowel,echogenic intracardiac focus and choroid plexus cyst,that is used to identify morphological features of fetal Down’s syndrome with a potential sensitivity of more than 90%.Other specific and sensitive markers can be seen in the case of cardiac defects and skeletal anomalies.In the future,sonographic markers could limit even more the use of invasive and dangerous techniques of prenatal diagnosis(amniocentesis,etc.).展开更多
A biloma is a rare disease characterized by an abnormal intra-or extrahepatic bile collection due to a traumatic or spontaneous rupture of the biliary system.Laboratory findings are nonspecific.The diagnosis is usuall...A biloma is a rare disease characterized by an abnormal intra-or extrahepatic bile collection due to a traumatic or spontaneous rupture of the biliary system.Laboratory findings are nonspecific.The diagnosis is usually suspected on the basis of a typical history(right upper quadrant abdominal pain,chills,fever and recent abdominal trauma or surgery) and is confirmed by detection of typical radiologic features.We report the case of a patient with a history of previous cholecystectomy for lithiasis who presented with clinical symptoms and laboratory data suggestive of acute pancreatitis.Imaging studies also revealed the presence of a chronic and asymptomatic biloma,which could be mistaken for a pseudocyst.The atypical location and ultrasound findings suggested an alternative diagnosis.We therefore reviewed the known literature for bilomas,focusing on the role of ultrasonography,which can reveal some typical aspects,such as location and imaging features.Weconclude that ultrasound plays a key role in the assessment of a suspected biloma in patients with appropriate history and clinical features and provides valuable diagnostic clues even in the absence of these.展开更多
Carpal tunnel syndrome(CTS) is a common peripheral entrapment neuropathy of the median nerve at wrist level, and is thought to be caused by compression of the median nerve in the carpal tunnel. There is no standard qu...Carpal tunnel syndrome(CTS) is a common peripheral entrapment neuropathy of the median nerve at wrist level, and is thought to be caused by compression of the median nerve in the carpal tunnel. There is no standard quantitative reference for the diagnosis of CTS. Greyscale sonography and sonoelastography(SEL) have been used as diagnostic tools. The most commonly agreed findings in grey-scale sonography for the diagnosis of CTS is enlargement of the median nerve cross-sectional area(CSA). Several authors have assessed additional parameters. "Delta CSA" is the difference between the proximal median nerve CSA at the pronator quadratus and the maximal CSA within the carpal tunnel. The "CSA ratio" is the ratio of CSA in the carpal tunnel to the CSA at the mid forearm. These additional parameters showed better diagnostic accuracy than CSA measurement alone. Recently, a number of studies have investigated the elasticity of the median nerve using SEL, and have shown that this also has diagnostic value, as it was significantly stiffer in CTS patients compared to healthy volunteers. In this review, we summarize the usefulness of grey-scale sonography and SEL in diagnosing CTS.展开更多
AIM: To evaluate in a multicenter study whether the sonographic characterization of focal liver lesions can be improved using SonoVueüà-enhancement; and to compare this method with computed tomography (CT) a...AIM: To evaluate in a multicenter study whether the sonographic characterization of focal liver lesions can be improved using SonoVueüà-enhancement; and to compare this method with computed tomography (CT) and magnetic resonance imaging (MRI). METHODS: One hundred and thirty four patients with one focal liver lesion detected in baseline ultrasound (US) were examined with conventional US, contrastenhanced US (n = 134), contrast-enhanced CT (n = 115) and/or dynamic contrast-enhanced MRI (n = 70). The lesions were classified as malignant, benign or indeterminate and the type of lesion was determined. The f inal diagnosis based on the combined information of all imaging examinations, clinical information and histology (n = 32) was used. Comparisons were made to see whether the addition of contrast-enhanced US led to the improvement of the characterization of doubtful focal liver lesions. RESULTS: In comparison with unenhanced US, SonoVue markedly improves sensitivity and specificity for the characterization (malignant/benign) of focal liver lesions. In comparison with CT and/or dynamic MRI, SonoVueüà -enhanced sonography applied for characterization of focal liver lesions was 30.2% more sensitive in the recognition of malignancy and 16.1% more specific in the exclusion of malignancy and overall 22.9% more accurate. In the subgroup with confirmative histology available (n = 30), sensitivity was 95.5% (CEUS), 72.2% (CT) and 81.8% (MRI), and specif icity was 75.0% (CEUS), 37.5% (CT) and 42.9% (MRI). The sensitivity and specif icity of CEUS for the identif ication of focal nodular hyperplasia (FNH) and hemangiomas was 100% and 87%, resulting in an accuracy of 94.5%. CONCLUSION: SonoVueüà-enhanced sonography emerges as the most sensitive, most specif ic and thus most accurate imaging modality for the characterization of focal liver lesions.展开更多
Ultrasonography(US) findings are inevitably based on pathological features.Knowledge of the pathological features of hepatic malignancies such as hepatocellular carcinoma(HCC),liver metastasis and intrahepatic cholang...Ultrasonography(US) findings are inevitably based on pathological features.Knowledge of the pathological features of hepatic malignancies such as hepatocellular carcinoma(HCC),liver metastasis and intrahepatic cholangiocarcinoma is essential for correct US diagnosis and appropriate management.One type of hepatocarcinogenesis is step-wise development from a low-grade dysplastic nodule(DN),high-grade DN,high-grade DN with malignant foci,and well-differentiated HCC,to classical HCC.The intranodular blood supply changes in accordance with this progression.Moreover,the malignant potential tends to change as the macroscopic configuration progresses.Therefore,typical US findings of advanced HCC are a mosaic pattern,septum formation,peripheral sonolucency(halo),lateral shadow produced by fibrotic pseudocapsule,posterior echo enhancement,arterial hypervascularity with dilated intratumoral blood sinusoids,and perinodular daughter nodule formation.Bull's eye appearance is a common presentation of metastases from gastrointestinal(GI) adenocarcinomas,and represents histological findings that show an area of central necrosis surrounded by a zonal area of viable tumor.Thick zonal area reflects the layer of viable cells that are fed by minute tumor vessels.US imaging features of liver metastases from the GI tract are as follows:Bull's eye appearance,multiple masses,irregular tumor border,arterial rim-like enhancement,and hypoenhancement in the late vascular phase.Most intrahepatic cholangiocarcinomas are ductal adenocarcinomas.The bile ducts peripheral to the tumor are usually dilated because of obstruction by tumors.US imaging features of mass-forming cholangiocarcinoma are as follows:peripheral bile duct dilatation,irregular tumor border,arterial enhancement due to minute intratumoral blood sinusoids,and hypoenhancement in the late vascular phase.展开更多
基金Supported by the Health Department of Guangdong Province(B2011259)
文摘Objective To investigate diagnostic efficacy of transvaginal three-dimensional hysterosalpingo-contrast sonography(3D-Hy Co Sy) in assessing tubal patency with chromolaporoscopy. Methods A total of 157 infertile women underwent 3D-Hy Co Sy to evaluate tubal patency. Among these patients, 39 patients were also examined by chromolaporoscopy. The concordance of the two clinical assessment methods was analyzed by the Kappa coefficient test. Results Among the 306 oviducts examined by 3D-Hy Co Sy, 99(32.4%) were patent, 126(41.2%) partially obstructed, and 81(26.5%) completely obstructed. Diagnostic results with 3D-Hy Co Sy were not statistically different from those obtained in the 39 women(78 oviducts) who also underwent chromolaporoscopy, and the two methods showed a high concordance(κ=0.747, P=0.000). The 3D-Hy Co Sy procedure had a sensitivity of 84.8%(28/33), a specificity of 96.2%(25/26), and positive and negative predictive values of 93.3%(28/30) and 86.2%(25/29) respectively. Conclusion Transvaginal 3D-Hy Co Sy can accurately reveal the spatial path and morphology of the oviduct and is a safe and effective method to evaluate tubal patency.
基金the National Natural Science Foundation of China,No.81460133Innovation Program of regional Cooperation of Xinjiang Uygur Autonomous region,No.2016E02063
文摘AIM To evaluate the diagnostic value of different sonographic methods in hemorrhoids.METHODSForty-two healthy volunteers and sixty-two patients with gradesⅠ-Ⅳhemorrhoids received two different sonographic examinations from January 2013 to January2016 at the First and Second Hospitals of Xinjiang Medical University in a prospective way.We analyzed the ultrasonographic findings of these participants and evaluated the outcomes.Resected gradesⅢandⅣhemorrhoid tissues were pathologically examined.The concordance of ultrasonographic results with pathologyresults was assessed with the Cohen’s kappa coefficient.RESULTS All healthy volunteers and all patients had no particular complications related to sonography.There were no statistically significant differences between the participants regarding age(P=0.5919),gender(P=0.4183),and persistent symptoms(P>0.8692).All healthy control participants had nospecial findings.However,30 patients with hemorrhoids showed blood signals around the dentate line on ultrasonography.When gradesⅠandⅡhemorrhoids were analyzed,there were no significant differences between transrectal ultrasound(TRUS),transperianal ultrasound(TPUS),and transvaginal ultrasound(TVUS)(P>0.05).GradesⅢandⅣhemorrhoids revealed blood flow with different directions which could be observed as a"mosaic pattern".In patients with gradesⅢandⅣhemorrhoids,the number of patients with"mosaic pattern"as revealed by TRUS,TPUS and TVUS was 22,12,and 4,respectively.Patients with gradesⅢandⅣdisease presented with a pathologically abnormal cushion which usually appeared as a"mosaic pattern"in TPUS and an arteriovenous fistula in pathology.Subepithelial vessels of resected gradesⅢandⅣhemorrhoid tissues were manifested by obvious structural impairment and retrograde and ruptured changes of internal elastic lamina.Some parts of the Trietz’s muscle showed hypertrophy and distortion.Arteriovenous fistulas and venous dilatation were obvious in the anal cushion of hemorhoidal tissues.After pathological results with arteriovenous fistulas were taken as the standard reference,we evaluated the compatibility between the two methods according to the Cohen’s kappa coefficiency calculation.The compatibility(Cohein kappa co-efficiency value)between"mosaic pattern"in the TPUS and arteriovenous fistula in pathology was very good(?=0.8939).When compared between different groups,TRUS presented the advantage that the mosaic pattern could be confirmed in more patients,especially for group A.There was a statistical difference when comparing group A with group B or C(P<0.05 for both).There were obvious statistical differences between group A and group B with regard to the vessel diameter and blood flow velocity measured by TRUS(P<0.05).CONCLUSION Patients with gradesⅢandⅣhemorrhoids present with a pathologically abnormal cushion which usually appears as a"mosaic pattern"in sonography,which is in accord with an arteriovenous fistula in pathology.There are clearly different hemorrhoid structures shown by sonography."Mosaic pattern"may be a parameter for surgical indication of gradesⅢandⅣhemorrhoids.
文摘BACKGROUND： A preoperative diagnosis of primary hepatic lymphoma（PHL） can have profound therapeutic and prognostic implications. Because of the rarity of PHL, however, there are few reports on diagnostic imaging. We reviewed the clinical and radiologic findings of 29 patients with PHL, the largest series to date, to evaluate the diagnostic features of this disease.METHODS： Clinical data and radiologic findings at presentation were retrospectively reviewed for 29 patients with pathologically confirmed PHL from January 2005 to June 2013. Imaging studies, including ultrasound（US）（n=29） and contrast-enhanced computed tomography（CECT）（n=24）, were performed within 2 weeks before biopsy or surgery.RESULTS： Among the 29 patients, 23（79%） were positive for hepatitis B virus（HBV） and 26（90%） had a significantly elevated level of serum lactate dehydrogenase（LDH）. There were two distinct types of PHL on imaging： diffuse（n=5） and nodular（n=24）. Homogeneous or heterogeneous hepatomegaly was the only sign for diffuse PHL on both US and CECT, without any definite hepatic mass. For the nodular type, 63%（15/24） of patients had solitary lesions and 38%（9/24） had multiple lesions. On US, seven patients displayed patchy distribution with an indistinct tumor margin and a rich color flow signal. CECT showed rim-like enhancement（n=3） and slightly homogeneous or heterogeneous enhancement（n=14） in the arterial phase and isoenhancement（n=5） and hypoenhancement（n=12） in the portal venous and late phases. Furthermore, in five patients, CT revealed that hepatic vessels passed through the lesions and were not displaced from the abnormal area or appreciably compressed.CONCLUSIONS： The infiltration type of PHL was associated with the histologic subtype. Considered together with HBV positivity and elevated LDH, homogeneous or heterogeneous hepatomegaly may indicate diffuse PHL, whereas patchy distribution with a rich color flow signal on US or normal vessels extending through the lesion on CECT may be the diagnostic indicators of nodular PHL.
文摘BACKGROUND Neuropathy is a common complication of diabetes mellitus resulting from direct damage by hyperglycemia to the nerves and/or ischemia by microvascular injury to the endoneurial vessels which supply the nerves. Median nerve is one of the peripheral nerves commonly affected in diabetic neuropathy. The median nerve size has been studied in non-Nigerian diabetic populations. In attempt to contribute to existing literature, a study in a Nigerian population is needed.AIM To evaluate the cross-sectional area(CSA) of the median nerve using B-mode ultrasonography(USS) and the presence of peripheral neuropathy(PN) in a cohort of adult diabetic Nigerians.METHODS Demographic and anthropometric data of 85 adult diabetes mellitus(DM) and 85 age-and sex-matched apparently healthy control(HC) subjects were taken. A complete physical examination was performed on all study subjects to determine the presence of PN and modified Michigan Neuropathy Screening Instrument(MNSI) was used to grade its severity. Venous blood was taken from the study subjects for fasting lipid profile(FLP), fasting blood glucose(FBG) and glycated haemoglobin(HbA1 c) while their MN CSA was evaluated at a point 5 cm proximal to(5 cmCATL) and at the carpal tunnel(CATL) by high-resolution Bmode USS. Data was analysed using SPSS version 22.RESULTS The mean MN CSA was significantly thicker in DM subjects compared to the HC at 5 cmCATL(P < 0.01) and at the CATL(P < 0.01) on both sides. The presence of diabetic peripheral neuropathy(DPN) further increased the MN CSA at the CATL(P < 0.05) but not at 5 cmCATL(P > 0.05). However, the severity of DPN had no additional effect on MN CSA 5 cm proximal to and at the CATL. There was no significant association between MN CSA and duration of DM and glycemic control.CONCLUSION Thickening of the MN CSA at 5 cmCATL and CATL is seen in DM. Presence of DPN is associated with worse thickening of the MN CSA at the CATL but not at5 cmCATL. Severity of DPN, duration of DM, and glycemic control had no additional effect on the MN CSA.
基金Supported by FESR P.O.Apulia Region 2007-2013-Action 1.2.4(grant number 3Q5AX31)the National Council of Research Project AMOLAB
文摘Fetal malformations are very frequent in industrialized countries.Although advanced maternal age may affect pregnancy outcome adversely,80%-90%of fetal malformations occur in the absence of a specific risk factor for parents.The only effective approach for prenatal screening is currently represented by an ultrasound scan.However,ultrasound methods present two important limitations:the substantial absence of quantitative parameters and the dependence on the sonographer experience.In recent years,together with the improvement in transducer technology,quantitative and objective sonographic markers highly predictive of fetal malformations have been developed.These markers can be detected at early gestation(11-14 wk)and generally are not pathological in themselves but have an increased incidence in abnormal fetuses.Thus,prenatal ultrasonography during the second trimester of gestation provides a"genetic sonogram",including,for instance,nuchal translucency,short humeral length,echogenic bowel,echogenic intracardiac focus and choroid plexus cyst,that is used to identify morphological features of fetal Down’s syndrome with a potential sensitivity of more than 90%.Other specific and sensitive markers can be seen in the case of cardiac defects and skeletal anomalies.In the future,sonographic markers could limit even more the use of invasive and dangerous techniques of prenatal diagnosis(amniocentesis,etc.).
文摘A biloma is a rare disease characterized by an abnormal intra-or extrahepatic bile collection due to a traumatic or spontaneous rupture of the biliary system.Laboratory findings are nonspecific.The diagnosis is usually suspected on the basis of a typical history(right upper quadrant abdominal pain,chills,fever and recent abdominal trauma or surgery) and is confirmed by detection of typical radiologic features.We report the case of a patient with a history of previous cholecystectomy for lithiasis who presented with clinical symptoms and laboratory data suggestive of acute pancreatitis.Imaging studies also revealed the presence of a chronic and asymptomatic biloma,which could be mistaken for a pseudocyst.The atypical location and ultrasound findings suggested an alternative diagnosis.We therefore reviewed the known literature for bilomas,focusing on the role of ultrasonography,which can reveal some typical aspects,such as location and imaging features.Weconclude that ultrasound plays a key role in the assessment of a suspected biloma in patients with appropriate history and clinical features and provides valuable diagnostic clues even in the absence of these.
文摘Carpal tunnel syndrome(CTS) is a common peripheral entrapment neuropathy of the median nerve at wrist level, and is thought to be caused by compression of the median nerve in the carpal tunnel. There is no standard quantitative reference for the diagnosis of CTS. Greyscale sonography and sonoelastography(SEL) have been used as diagnostic tools. The most commonly agreed findings in grey-scale sonography for the diagnosis of CTS is enlargement of the median nerve cross-sectional area(CSA). Several authors have assessed additional parameters. "Delta CSA" is the difference between the proximal median nerve CSA at the pronator quadratus and the maximal CSA within the carpal tunnel. The "CSA ratio" is the ratio of CSA in the carpal tunnel to the CSA at the mid forearm. These additional parameters showed better diagnostic accuracy than CSA measurement alone. Recently, a number of studies have investigated the elasticity of the median nerve using SEL, and have shown that this also has diagnostic value, as it was significantly stiffer in CTS patients compared to healthy volunteers. In this review, we summarize the usefulness of grey-scale sonography and SEL in diagnosing CTS.
文摘AIM: To evaluate in a multicenter study whether the sonographic characterization of focal liver lesions can be improved using SonoVueüà-enhancement; and to compare this method with computed tomography (CT) and magnetic resonance imaging (MRI). METHODS: One hundred and thirty four patients with one focal liver lesion detected in baseline ultrasound (US) were examined with conventional US, contrastenhanced US (n = 134), contrast-enhanced CT (n = 115) and/or dynamic contrast-enhanced MRI (n = 70). The lesions were classified as malignant, benign or indeterminate and the type of lesion was determined. The f inal diagnosis based on the combined information of all imaging examinations, clinical information and histology (n = 32) was used. Comparisons were made to see whether the addition of contrast-enhanced US led to the improvement of the characterization of doubtful focal liver lesions. RESULTS: In comparison with unenhanced US, SonoVue markedly improves sensitivity and specificity for the characterization (malignant/benign) of focal liver lesions. In comparison with CT and/or dynamic MRI, SonoVueüà -enhanced sonography applied for characterization of focal liver lesions was 30.2% more sensitive in the recognition of malignancy and 16.1% more specific in the exclusion of malignancy and overall 22.9% more accurate. In the subgroup with confirmative histology available (n = 30), sensitivity was 95.5% (CEUS), 72.2% (CT) and 81.8% (MRI), and specif icity was 75.0% (CEUS), 37.5% (CT) and 42.9% (MRI). The sensitivity and specif icity of CEUS for the identif ication of focal nodular hyperplasia (FNH) and hemangiomas was 100% and 87%, resulting in an accuracy of 94.5%. CONCLUSION: SonoVueüà-enhanced sonography emerges as the most sensitive, most specif ic and thus most accurate imaging modality for the characterization of focal liver lesions.
文摘Ultrasonography(US) findings are inevitably based on pathological features.Knowledge of the pathological features of hepatic malignancies such as hepatocellular carcinoma(HCC),liver metastasis and intrahepatic cholangiocarcinoma is essential for correct US diagnosis and appropriate management.One type of hepatocarcinogenesis is step-wise development from a low-grade dysplastic nodule(DN),high-grade DN,high-grade DN with malignant foci,and well-differentiated HCC,to classical HCC.The intranodular blood supply changes in accordance with this progression.Moreover,the malignant potential tends to change as the macroscopic configuration progresses.Therefore,typical US findings of advanced HCC are a mosaic pattern,septum formation,peripheral sonolucency(halo),lateral shadow produced by fibrotic pseudocapsule,posterior echo enhancement,arterial hypervascularity with dilated intratumoral blood sinusoids,and perinodular daughter nodule formation.Bull's eye appearance is a common presentation of metastases from gastrointestinal(GI) adenocarcinomas,and represents histological findings that show an area of central necrosis surrounded by a zonal area of viable tumor.Thick zonal area reflects the layer of viable cells that are fed by minute tumor vessels.US imaging features of liver metastases from the GI tract are as follows:Bull's eye appearance,multiple masses,irregular tumor border,arterial rim-like enhancement,and hypoenhancement in the late vascular phase.Most intrahepatic cholangiocarcinomas are ductal adenocarcinomas.The bile ducts peripheral to the tumor are usually dilated because of obstruction by tumors.US imaging features of mass-forming cholangiocarcinoma are as follows:peripheral bile duct dilatation,irregular tumor border,arterial enhancement due to minute intratumoral blood sinusoids,and hypoenhancement in the late vascular phase.
